Quality improvement evaluation of postoperative wound dressings in orthopaedic patients.

Dressings play a key role in postoperative wound care, as clinicians aim to optimise the wound healing environment (including optimal exudate management) and prevent complications such as infection and blistering. Excess exudate can lead to wound breakdown, increased bacterial burden and delaying healing, causing an increased risk of wound infection (superficial) and ultimately increasing the risk of surgical site infection (SSI) (deep infection at the site of the prosthesis). This article describes the evaluation of different postoperative dressings in use within the orthopaedic department of a tertiary hospital, as part of a quality improvement program aimed at evaluating the performance of postoperative dressings and ensuring that the most appropriate dressing is used in the management of postoperative wounds in orthopaedic patients. Seven postoperative dressing types were assessed in 307 orthopaedic patients who had undergone surgery. Post-operative dressings were assessed in terms of their ability to handle exudate (in terms of both 'wet' exudate and 'dry' exudate). User satisfaction of the postoperative dressings was also captured. Dressing change frequency was also recorded. Dressing wear was captured in terms of whether the post-operative dressing under evaluation was still in place at the time the patient was discharged (if the primary dressing required changing, it was replaced with Tegderm™ +Pad, as per current hospital practice.) Most healthcare professionals were satisfied, very satisfied or extremely satisfied with the ease of application of the dressings: Mepore® non-occlusive fabric dressing (96%) (current practice), Opsite® Post-Op Visible (95%), Leukomed® Control (94%), Sorbact® (green) surgical dressing (90%), Mepilex® Border Post-Op (87%), Tegaderm®+Pad (76%) and Aquacel® Ag Surgical (73%). The high satisfaction rates for Mepore® may have been influenced by the familiarity with this dressing which, at the time, was the standard current practice dressing. This dressing was ruled out for future use due to it being non-occlusive. Opsite® Post-Op Visible (second highest rating) was associated with three adverse events. Sorbact® surgical dressing was rated fourth in terms of healthcare professional satisfaction with regards to ease of application but was associated with the highest amount (24%) of wet exudate. Mepilex® Border Post-Op (rated fifth for ease of application; 5% wet exudate) was preferred overall because of its flexibility and small amount of wet exudate, ahead of Leukomed® Control (rated third for ease of application; 12% wet exudate), which had more frequent dressing changes than recommended by the manufacturer. A contributory factor to this may have been the dressing's transparency and the ability to observe the small amount of exudate and the nurse feeling the need to change it. In response to the findings of the quality improvement program, a new protocol of care at the major metropolitan teaching hospital has been implemented; for patients undergoing orthopaedic surgery, Mepilex® Border Post-Op (Mölnlycke) is now routinely applied in theatre and is left intact for 7 days as per the manufacturer's recommendations. Since this change in practice and the introduction of Mepilex® Border Post-Op, the incidence of SSIs at this hospital has reduced.

The relationship between weight and pulmonary outcomes in overweight and obese people with cystic fibrosis: A retrospective observational study.

Background: A major focus in cystic fibrosis (CF) care aims to increase weight gain. Rates of overweight and obese people with CF have gradually increased over the past decade. Obesity could be a risk for restriction of lung volumes and airway obstruction as well as increase rates of pulmonary exacerbations in people with CF. Aim: To assess the relationship between weight categories and pulmonary outcomes in children and adults with CF. Methods: Patients 6 years of age and older were categorized into weight categories based on the Centers for Disease Control and Prevention (CDC) definitions. A retrospective chart review was conducted to obtain lung function testing and other outcomes. Results: One hundred five patients with a median age of 20.6 years were included in this analysis. 8.4%, 64%, 18%, and 10% of patients were underweight, normal/healthy weight, overweight, and obese, respectively. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) (% predicted) did not differ between patients with weights in the normal range versus patients in the overweight/obese categories. Linear regression analysis showed a direct correlation between body mass index (BMI) and FEV1 that continued as BMI entered overweight and obese categories in both pediatric and adult patients. Overweight/obese patients did not have increased rates of pulmonary exacerbations compared to those in the normal/healthy weight category. Conclusion: As CF therapies continue to improve, an increasing number of people with CF are exceeding the CDC's normal-weight range. Gaining weight past the normal range does not appear to negatively impact pulmonary health of people with CF. If this trend of increased weight gain continues, it remains to be seen if it will eventually negatively affect lung health.

Adipogenic human adenovirus Ad-36 induces commitment, differentiation, and lipid accumulation in human adipose-derived stem cells.

Human adenovirus Ad-36 is causatively and correlatively linked with animal and human obesity, respectively. Ad-36 enhances differentiation of rodent preadipocytes, but its effect on adipogenesis in humans is unknown. To indirectly assess the role of Ad-36-induced adipogenesis in human obesity, the effect of the virus on commitment, differentiation, and lipid accumulation was investigated in vitro in primary human adipose-derived stem/stromal cells (hASC). Ad-36 infected hASC in a time- and dose-dependent manner. Even in the presence of osteogenic media, Ad-36-infected hASC showed significantly greater lipid accumulation, suggestive of their commitment to the adipocyte lineage. Even in the absence of adipogenic inducers, Ad-36 significantly increased hASC differentiation, as indicated by a time-dependent expression of genes within the adipogenic cascade-CCAAT/Enhancer binding protein-beta, peroxisome proliferator-activated receptor-gamma, and fatty acid-binding protein-and consequentially increased lipid accumulation in a time- and viral dose-dependent manner. Induction of hASC to the adipocyte state by Ad-36 was further supported by increased expression of lipoprotein lipase and the accumulation of its extracellular fraction. hASC from subjects harboring Ad-36 DNA in their adipose tissue due to natural infection had significantly greater ability to differentiate compared with Ad-36 DNA-negative counterparts, which offers a proof of concept. Thus, Ad-36 has the potential to induce adipogenesis in hASC, which may contribute to adiposity induced by the virus.

Ten putative contributors to the obesity epidemic.

The obesity epidemic is a global issue and shows no signs of abating, while the cause of this epidemic remains unclear. Marketing practices of energy-dense foods and institutionally-driven declines in physical activity are the alleged perpetrators for the epidemic, despite a lack of solid evidence to demonstrate their causal role. While both may contribute to obesity, we call attention to their unquestioned dominance in program funding and public efforts to reduce obesity, and propose several alternative putative contributors that would benefit from equal consideration and attention. Evidence for microorganisms, epigenetics, increasing maternal age, greater fecundity among people with higher adiposity, assortative mating, sleep debt, endocrine disruptors, pharmaceutical iatrogenesis, reduction in variability of ambient temperatures, and intrauterine and intergenerational effects as contributing factors to the obesity epidemic are reviewed herein. While the evidence is strong for some contributors such as pharmaceutical-induced weight gain, it is still emerging for other reviewed factors. Considering the role of such putative etiological factors of obesity may lead to comprehensive, cause specific, and effective strategies for prevention and treatment of this global epidemic.

Adipogenic cascade can be induced without adipogenic media by a human adenovirus.

Several metabolic abnormalities are associated with relative excess or deficiency of adipose tissue. Identifying the regulators of adipogenic differentiation is critical for its successful manipulation. Ad36, a human adenovirus, is a novel factor that promotes adipogenesis. We exploited the adipogenic potential of Ad36 to reveal exogenous modifiers of adipogenesis in rodent preadipocyte cell line in the presence or absence of differentiation inducers methyl-isobutyl-xanthine, dexamethasone, and insulin (M, D, and I; MDI). A nonadipogenic human adenovirus Ad2 was used as a negative control for viral infection. First, we confirmed that, Ad36, but not Ad2, increases lipid accumulation in the presence or absence of MDI. Time-course studies for expression of key genes of adipogenic cascade showed that it is Ad36, but not Ad2, which downregulated preadipocyte marker gene Wnt10b, and upregulated expression of early (C/EBPDelta and C/EBPbeta), intermediate (PPARgamma2), and late genes (aP2 and G3PDH) of adipogenic cascade even in the absence of MDI. In the presence of MDI, onset of expression of adipogenic genes coincided for Ad36 and control groups, but the expressions were significantly greater for the Ad36 group. Next, we observed that attenuation of Ad36 mRNA expression by an antiadenoviral agent reduced 3T3-L1 differentiation, indicating that viral mRNA expression is required for the process. Furthermore, with or without MDI or its components, Ad36 significantly increased lipid accumulation in 3T3-L1 cells. Cell confluency at the time of Ad36 infection positively influenced lipid accumulation. The results reveal that Ad36 is an MDI-independent exogenous regulator of the adipogenic process. Elucidating the molecular pathways involved may reveal novel regulatory controls of adipogenesis.